| Robert Benavides Jr. | |
|
2455 Bennett Valley Rd #210 C Santa Rosa CA 95404-5663 | |
| (707) 542-2081 | |
| Not Available |
| Full Name | Robert Benavides Jr. |
|---|---|
| Speciality | Psychologist |
| Location | 2455 Bennett Valley Rd, Santa Rosa, California |
| Authorized Official Name and Position | Robert Benavides (OWNER) |
| Authorized Official Contact | 7075422081 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Robert Benavides Jr. 2455 Bennett Valley Rd #210 C Santa Rosa CA 95404-5663 Ph: (707) 542-2081 | Robert Benavides Jr. 2455 Bennett Valley Rd #210 C Santa Rosa CA 95404-5663 Ph: (707) 542-2081 |
| NPI Number | 1386674059 |
|---|---|
| Provider Enumeration Date | 07/05/2006 |
| Last Update Date | 08/22/2020 |
| Medicare PECOS PAC ID | 0042392953 |
|---|---|
| Medicare Enrollment ID | O20080131000251 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1386674059 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103T00000X | Psychologist | PSY11363 (California) | Primary |
| Provider Name | Robert Benavides |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1487638714 PECOS PAC ID: 3779665682 Enrollment ID: I20080131000246 |
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